PAINLESS CHILDBIRTH— SOMETIMES
Though more and more doctors see merit in the Read system of avoiding labor pains many still insist that anaesthesia and surgery at the actual birth are important to the welfare of the mother
THE hospital’s maternity floor was hushed. The crying of newborn babies in the nursery was inaudible down the wide hall. Behind a door marked Delivery Room, motherhood’s chamber of travail, there was no sound. The door swung open silently and a nurse hurried out, looking back in consternation. “Good gosh!” she said to a group at the reception desk. “There’s a woman in there having a baby and she’s reading a book.”
A slender young woman turned from the group and beamed. “Aha,” she said, “my patient.”
She was Dorothy Madge!I, Toronto physio-
therapist currently instructing pregnant women in the science of relaxing during childbirth. The theory has been advanced, and proven, that it is possible to go without anaesthetic and not suffer a labor pain. In hospitals all over the continent women are being wheeled into the delivery room in the last stages of labor, fully conscious and calmly buffing their nails.
But while most doctors in Canada seem to agree that it’s a fine thing for a woman to get through her labor naturally without drugs or gas the great majority believe that, at the moment of birth, a quick anaesthetic and the application of surgical science will not only help the baby but safeguard against serious damage to the mother.
One curious handicap of the new relax-and-it-
won’t-hurt philosophy is that doctors who customarily rely on the patient’s moans to indicate the proximity of birth are entirely at sea. One of Miss Madgett’s patients was waiting at her home until her contractions were close enough to assure her that there was no chance of a false alarm. Since she was having no pain the only way she could time her contractions was to keep her hand on the top of her abdomen and wait for the hardening of the muscles. When these knotting-up sensations were three minutes apart she phoned her doctor and announced gaily that she was ready.
“Get back to bed,” her doctor growled. “You’re no more ready to have a baby than I am.”
The woman became panicky and began to tighten up instead of relaxing. Immediately her pains became real and violent. She phoned Dorothy Madgett sobbing and was advised to call the doctor again. This time he was convinced.
Another woman was reading a detective story in the labor room, religiously relaxing when she felt her contractions starting. Her doctor poked her head through the door and enquired genially how things were coming along.
“Just fine,” the patient smiled back. “I’m having a contraction now. Do you want to feel and see how it is?”
“Nope,” answered the doctor, sliding back into the hall. “I’ve been delivering babies for 20 years.
I can tell by your face that you’ve quite a while yet.”
Twenty minutes later the expectant mother was on the delivery table, a nurse was hunting for the doctor and another was holding her knees together so the baby wouldn’t be born unattended. When the anaesthetist arrived the patient protested she wasn’t suffering a bit.
“I Pushed For All I Was Worth”
THESE cases, where the mothers got through their labor without pain and without drugs then got an anaesthetic at the very last moment, are still uncommon enough on maternity floors to cause a stir among the staff. But the four-star sensations are the women who, despite the dour warnings of their doctors, have an entire childbirth without anaesthetic.
Two months ago one of Madgett’s pupils, Mrs. Brenda Pemberton-Pigott, a dark-eyed, vivid English physiotherapist, became a seven-day wonder at Toronto East General Hospital where her baby was delivered. Mrs. Pigott’s labor lasted about 20 hours and from the first twinge in her back until she walked off the delivery table the mother of an eight-pound girl, she didn’t take so much as an aspirin. She reports that her main source of discomfort is boredom at having to repeat the details 16 times a day to her friends and neighbors.
“When my contractions started,” she relates, avoiding the obsolete word “pain,” “I walked around a bit, dropping into a chair and relaxing whenever I felt my abdomen hardening. Dorothy (Madgett) came into the labor room with me and we talked. As physiotherapists it was very interesting to us.
“The most uncomfortable time was just before the bearing-down period started. I started to toss my head from side to side on the pillow and I heard myself say, T don’t know what to do, I just don’t know what to do.’
“Once I had started to bear down I began to really enjoy myself. I took a deep breath at the beginning of each contraction, leaned my ribs down on the baby and pushed for all I was worth. The harder I pushed the better it felt. In-between I relaxed. Suddenly I had the feeling that something had gone. I thought ‘Oh oh, I’ve torn myself.’ I stopped bearing down immediately and did little panting breaths. I felt this sensation of splitting and it took all my concentration to keep relaxed. Finally, the baby’s shoulders appeared and the splitting sensation stopped. They held up my baby and I saw we had a daughter.”
She Had All The Trimmings
MRS. PIGOTT watched them put a tube in the baby’s mouth and suck out the mucus in her throat. Immediately the child began to cry. The doctor hadn’t used forceps at all so the baby’s head had no bruises.
In the last moments of birth Mrs. Pigott suffered a tear in the birth canal but, as soon as the doctor sewed this up, she began her exercises to get her tummy back to normal, contracting and relaxing her muscles.
A nurse came to her side and said the doctor had instructed that the patient could walk back to her room. Another nurse was incredulous, checked with the doctor again. He said “Sure, let her.” So Mrs. Pigott walked into the labor room, put on the slippers and dressing gown she had left there and strolled back to her room, severely jolting her roommate who had been waiting for the stretcher table.
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The final flamboyant touch of Mrs. Pigott walking back to her room impresses laymen more than it does the medical profession. In theory it is possible for any woman to walk away from a norma] delivery; in practice it is only encouraged in cases of fire or flood.
“She wanted a natural childbirth,” smiled her obstetrician, Dr. Gordon Chambers. “I figured she might as well have all the trimmings.”
“It must be understood,” he commented a few days after the delivery, “that Mrs. Pigott is an unusually determined woman. If she decided it wouldn’t hurt for me to cut off her leg then she’d have me do it without an anaesthetic and it wouldn’t hurt. She is by no means an average patient.”
Mrs. Pigott, and the hundreds of women who have anaesthetic only for the actual delivery of their babies, are not to be confused with heroes who gallantly refuse the blindfold when facing the firing squad. Women who have studied the method thoroughly, who have in some cases trained under an instructor, and in all cases believe wholeheartedly that it is possible, actually suffer no labor pains.
That First Breath Thrill
The theory that having a baby won’t hurt if you relax was first advanced by Dr. Grantley Dick Read, in a book “Childbirth Without Fear.” The method, known professionally as physiological labor or natural childbirth, is based on the mother having intimate knowledge of the mechanics of birth, plus a fair skill in the art of relaxing. The former precludes fear of having a child, which Read claims causes the pain, and the latter helps the process of birth along.
Read’s method is used most extensively in England, where it was introduced, and during the past three years has been adopted experimentally on this continent by Yale University, which has set up a clinic in a New Haven hospital where all maternity patients are trained for natural childbirth.
The excitement of witnessing birth, the logic of Read’s explanation of labor pains, the thrill of watching their baby take its first breath combine to excite and challenge women who are bearing children. In addition there is the undeniable appeal to the ham in all women to do something unusual and cause a small flurry.
Pain is fear, says Read. The more frightened you are the more painful your labor will be. Your fear makes you tense, your muscles tighten to fight against the uterus which is gamely contracting, trying to get the baby started down the birth canal. The uterus is only a muscle doing its duty—
it doesn’t hurt to flex the muscle in your arm and it shouldn’t hurt to use any muscle in the body. If you relax and let the uterus perform its natural function, there will be no pain.
While maybe one woman in every five who visits an obstetrician this year will have heard of the Read method, very few—about one in 50—will ask their doctors to permit them to have a baby without an anaesthetic.
Most doctors flatly refuse; others gauge the patient’s determination, point out their objections and eventually agree. “Why shouldn’t I let them?” commented one specialist candidly. “I’m a gynaecologist too and if enough women have natural childbirth my old age will be secure.”
Nature, a Heedless Obstetrician
The medical profession in this country, with few exceptions, feels that natural childbirth will injure a woman. When a woman goes through a birth without anaesthetic the doctor is not able to perform what is called an episiotomy. This is the cut made at the opening of the vagina the instant before the baby emerges. By enlarging that opening at the crucial moment the great strain is removed from the fragile walls of the birth canal.
With a Read natural childbirth mother this cut cannot be done. It requires an anaesthetic, which violates the mother’s principles, or a local freezing with a hypodermic injection, which is nearly impossible to administer properly to a perspiring woman who is within minutes of seeing her baby. The result is that the woman may possibly have a jagged tear which doesn’t mend as well as a straight clean cut, or the walls of her vagina may be weakened. The Yale clinic is keeping careful case histories of its mothers to discover if this is true, but since the damage sometimes isn’t evident for 20 years this point is not likely to be cleared up in the near future.
“Frankly, nature is 'a heedless obstetrician,” observes Dr. Marion Hilliard, one of Canada’s outstanding women doctors. “It’s only concerned with getting the baby out and it doesn’t care about the mother. There have been cases where a woman had only one big pain and pushed her baby right out.
I had one such patient and I had to do 23 stitches inside her.”
According to Dr. Hilliard almost half a gynaecologist’s practice is made up of repairing organs injured during childbirth. “The proportion will decrease as we get into the generation of women who have had the advantages of modern obstetrics,” she believes. “As long as they don’t return to nature again.”
Although she believes that in the final moments of the birth process a local anaesthetic must be administered. Dr. Hilliard is one of the handful of Women’s College Hospital doctors who are otherwise enthusiastic about Read. She has the book in her waiting room, advises patients who are interested to take a course in relaxing. “It’s
been proven to us hero that Read is most beneficial to women in labor,” she comments.
It was proven by Dorothy Madgett, a soft-voiced, intelligent woman in her late 20’s, the only person in Canada who teaches Read’s method. After the war, when she was discharged from the Army, she took her diploma as a teacher of medical electricity at the University of Toronto and started to lecture medical students there on diathermy and kindred subjects. At the same time the Canadian Physiotherapy Association received permission at Women’s College Hospital to instruct prenatal clinic patients in relaxing to make their labor easier.
Madgett was asked to undertake this as well and, when the trickle of women who went into the delivery room calmly knitting became a stream, doctors in the hospital began to take notice. They noticed that women who were able to relax during their labor had a much shorter labor than women who writhed and fussed.
The exercises Dorothy Madgett emphasizes in her course teach breathing and relaxing. During the bearingdown period of labor it is enormously helpful to take a deep breath at the top of each bearing down. The rhythm of this “deep breath, now push” is taught women repetitiously long before they go to hospital.
The expectant mothers, grinning a little self - consciously, come to Madgett’s classroom once, a month, beginning in their fifth month of pregnancy. There they lie on blankets on the floor while she stands over them and in a singsong soporific voice lulls them into relaxing. “Let yourselves go, let everything go. Be heavy all over. You’re so heavy, so heavy. Now the floor is trying to lift you, but you’re a dead weight and you’re going to hold it
Her eyes flick along the row of women in their drawstring maternity dresses. “Let your mouths fall open,” she says softly. “It takes a separate muscle to hold your mouth closed. Let it go too.”
What If They Yell After All?
Last winter Madgett had three patients who had obtained their doctors’ permission to have their babies without anaesthetic. The woman who was expecting first, Mrs. Mary Marx, had what is known as primary inertia, a condition in which the contractions are weak and far apart right until the end. After 48 hours of weak contractions she was too exhausted to deliver the baby herself and was given spinal anaesthetic. This serves to emphasize that Read’s method can only be applied in cases of normal labor.
In Mrs. Pigott’s case she suffered a minute tear in her vagina, precisely the thing that doctors fear will happen if there is no episiotomy.
“Delivering Mrs. Pigott didn’t change my mind one bit about natural childbirth,” says her doctor, Gordon Chambers. “I think it is a mistake for a woman to have her first baby that way. In later years it is entirely probable that she’ll be coming back for repairs.
I can see its distinct value for labor, and possibly for women who have already had one or two babies, but not for first babies.”
Most significantly, physiotherapist Madgett is in complete agreement. “After watching Mrs. Pigott,” she said recently, “I don’t think I’d have my first baby without an anaesthetic.”
At the Y ale clinic anaesthetic is made available to any woman in labor who desires it, but to date only 8% of the women who trained for natural childbirth have requested gas.
What of tk.one mothers--those who for months carefully followed Head's principles and eagerly anticipated a natural birth orJv to fall short in the last moments? Will they suffer from guilt complexes? Toronto psychologist Reva Gerstein thinks it likely they will.
“It seems probable that a woman who trains to have her baby without an anaesthetic, tells her friends about it and then suffers pain and has to yell for gas the old-fashioned way will suffer from a feeling of guilt and inadequacy that could cause a great deal of harm,” she says.
This point is doubted by women like Mrs. Cherie Davidson, a young Brampton, Ont., mother who read Read’s book a year ago and trained herself in relaxing. She went right through labor without any sedation until the baby was ready to emerge.
“Toward the end I got curious,” she told friends later. “I hated to go right through without knowing what a labor pain was like, so I stopped relaxing and let myself have a pain. It hurt like a son of a gun. After that I didn’t get curious any more.”
Dr. Frank O’Leary, Toronto obstetrician, who delivered Mrs. Davidson’s baby for a colleague who was out of town, was astounded. “I walked in and this woman was lying on the delivery table perfectly relaxed and calm. I figured either she was full of sedative or had no business being out of the labor room, but when I examined her I discovered she was in the last stages of labor. She argued about it, but we gave her gas and put her down right away.”
Another woman who read “Childbirth Without Fear” only casually
decided to try it when her labor started. She relaxed so magnificently that she kept falling asleep in the labor room and she concluded sorrowfully in her waking moments that either she was not having labor at all or else it was going to be a long slow haul.
An interne who heard from the nurses that she had refused a sedative dropped by to discuss the Read system with her and, in the course of their conversation, he started to examine her. “Nurse!” he yelped. “Rush this woman into the delivery room!”
“The baby was right there and I didn’t even know it,” the woman said afterward. “I hadn’t bothered reading what to do in the final stages because I thought I’d never get that far so I didn’t know what to do next. I’ve been studying, though; next baby I’ll be all set.”